Intercondylar distal humerus fractures – surgical treatment and results

Allende, Christian; Allende, Bartolome T.; Allende, Bartolomé Luis; Bitar, Iván; Gonzalez, Gilberto

doi:10.1016/j.main.2004.02.005

Cited by 30 publications

(17 citation statements)

References 26 publications

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“…In the 1960s the Arbeitsgemeinschaft fur Osteosynthesefragen (AO) stated that the principles of management for distal humerus fractures are anatomical reduction, rigid fixation with double plating and early mobilization, and this way of approaching distal humeral fractures remains the gold standard in most fractures and nonunions, mainly when there is articular involvement [3,4,7,9,10]. But there are certain Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Zhao et al [5] reported 24 patients with comminuted intra-articular fractures treated with double band osteosynthesis achieving 83 % excellent or good results. Allende et al [7] reported on the use of tension bands in combination with other fixation methods for the treatment of intercondylar distal humerus fractures, concluding that they are a good alternative in comminuted distal fractures with osteoporotic bone. In our group of patients, the average age was 70 years, all fractures and nonunions united, and the fixation achieved was adequate to allow prompt postoperative motion in all cases, as early motion was one of the main objectives in the treatment of these injuries.…”

Section: Discussionmentioning

confidence: 99%

“…The latest reviews in treatment of distal humerus fractures emphasize the fact that dual plate fixation, with placement of a separate strong plate on each column, is indicated for all adult fractures involving both columns of the distal part of the humerus [3,4]; one author even states that failure to adhere to the principles of rigid fixation with a strong plate on each column can dramatically increase nonunion rates [3]. But, there are previous reports in the literature of comparable results achieved using double tension band osteosynthesis or combining tension bands with other fixation methods in supra and intercondylar humeral fractures instead of double plating for fixation of the condylar block to the shaft [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Double tension band osteosynthesis in transverse supracondylar distal humerus fractures and nonunions

Allende

Gutiérrez

Savoy

et al. 2012

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the objective and subjective results achieved after double tension band fixation in transverse extra-articular intracapsular supracondylar distal humerus fractures and nonunions in adults. Methods Nine patients presenting six fractures and three nonunions of the distal humerus, treated with double tension band wiring between 1998 and 2011, were retrospectively evaluated. Two fractures were type A2 and four type A3, and the nonunions were oligotrophic; all nine lesions had a supracondylar intracapsular transverse orientation, that passed through the olecranon fossa, in a direction parallel to the joint line, and they compromised both columns of the distal humerus. Patient's age averaged 70 years (range, 56-82). Results Follow-up averaged 24.6 months (range, 12-53). All fractures and nonunions united; there were no infections, elbow stiffness or heterotopic bone formations. DASH score at final follow-up averaged 14.2 points (range, 4-22). The analog scale of pain averaged 1.1 points (range, 0-3). Elbow range of motion averaged 100°(range, 100-120°). Flexion averaged 123°(range, 115-130°) and elbow extension loss averaged 15.5°(range, 10-25°).Conclusions The results achieved with double tension band fixation in transverse extra-articular intracapsular supracondylar distal humerus fractures and nonunions are comparable to the results that can be expected when using other available fixation methods; this technique is faster, less demanding and cheaper, and surgeons should have it in mind when leading with these particular types of distal humerus fractures and nonunions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Double tension band osteosynthesis in transverse supracondylar distal humerus fractures and nonunions

Allende

Gutiérrez

Savoy

et al. 2012

International Orthopaedics (SICOT)

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“…It is also significant that in the X-rays presented by both Eastwood and Morgan, good reduction of the fractures were noted. It has also been reviewed by Watson-Jones, Bickel and Perry and Evans and the consensus opinion is that the bag of bones technique is suitable for elderly patients in whom early ambulation is required [5] .…”

Section: Introductionmentioning

confidence: 99%

Clinical profile of patients with distal humerus intercondylar fractures

Baig¹,

Dasari²,

Rudraraju³

et al. 2018

Int. J. Orthop. Sci.

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Inter-condylar fracture of the distal humerus is uncommon injuries and is difficult and challenging fracture for treatment. Restoration of the articular surface of distal humerus must be nearly perfect and sufficiently rigid to permit early mobilization of the elbow if the results is to be satisfactory. This was a prospective study of 20 cases of intercondylar fracture of distal humerus in adults admitted to medial trust hospital. In our series of 20 cases, there were 9 males and 11 females with average of 44.1 years. 9 cases were due to direct fall and 11 road traffic accident, with predominance of left side (11). Out of 20 cases 5 (25%) were of RR type II, 12 (60%) were of RR III and 3 (15%) were of RR IV.Keywords: intercondylar; fracture; orif; humerus IntroductionInter-condylar fractures in adults are challenging to treat and require careful judgement and skill on the part of a surgeon. It may be impossible to secure any degree of accuracy in reduction by manipulation alone; and operative reduction and internal fixation presents considerable problems of surgical technique. In the young adult, it is important to obtain as near an anatomical reduction of the articular surfaces as possible. In the elderly patient with an excessively comminuted fracture in osteoporotic bone, fixation is often poor. It must be emphasized that any method of treatment that requires prolonged immobilization is likely to result in fibrosis and ankylosis of the joint [1] . Prior to 1960, the consensus favoured non-operative management because of poor operative results. Since the advent of modern implants and surgical techniques permitting rigid internal fixation and early motion, recent publications favour operative management [2] . The various methods of treatment are defended vigorously by their proponents. The most ardent are adherent of closed reduction; Watson-Jones doubted if results of internal fixation can ever be better than that of closed reduction. He said internal fixation is a difficult operation not to be taken lightly -"Anyone who has operated upon these badly broken and comminuted fractures of the lower end of the humerus must have been impressed by the extreme difficulty in fixing the fragments in their proper position". He stated that there can be little doubt that the worst treatment of comminuted inter-condylar fractures of the humerus is extensive operative reduction with internal fixation by triradiate plates, and many screws. Such operations by stripping the blood supply of the partly detached fragments and causing adhesion of muscles to bone cause serious stiffness. He was also of the opinion that since it is a flexion injury with forward displacement, it should not be immobilized in acute flexion. Even right-angled position is not entirely safe. He advised manipulation and immobilization in a plaster slab in the mid-flexed position as the safest conservative measure. The plaster slab is discarded in 2-3 weeks and the joint mobilized by the patient's own activity [3,4] . In 1937 Eastwood, advocated the ...

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“…The typical surgical approach is osteotomy of the olecranon. Potential complications of this approach include delayed bone healing, nonunion, malunion, olecranon separation, local eminence and loss of metal fixation [1,6,10,12,13,19]. Other exposure methods include the triceps-splitting approach [11,15], Bryan-Morrey approach [3,4,8], triceps-reflecting anconeus pedicle (TRAP) approach [16,17], and bone-anconeus flap approach [15,24].…”

Section: Introductionmentioning

confidence: 99%

Applied anatomical study of the modified anconeus flap approach

et al. 2015

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The present study has demonstrated a new approach for adequately exposing the distal humeral articular surface during surgery for an intercondylar humerus fracture. With this modified approach, osteotomy of the olecranon and the separation or transection of the main part of the triceps brachial tendon from the olecranon are not necessarily required. Therefore, we suggest that this novel approach could be applied as the primary surgical approach in intercondylar humerus fracture surgeries if the surgeons are familiar with the regional features of distal tendon of the triceps brachii and anconeus.

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Intercondylar distal humerus fractures – surgical treatment and results

Cited by 30 publications

References 26 publications

Double tension band osteosynthesis in transverse supracondylar distal humerus fractures and nonunions

Double tension band osteosynthesis in transverse supracondylar distal humerus fractures and nonunions

Clinical profile of patients with distal humerus intercondylar fractures

Applied anatomical study of the modified anconeus flap approach

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